Violence not part of job description

Study finds 75 per cent of nurses have experienced workplace violence and only 16 per cent make an official report.

A new report revealing a high level of violence against hospital nurses highlights the need for a shift in attitudes by both nurses and managers, says the researcher.

The study of 113 nurses in a Western Australia hospital found 75 per cent had experienced workplace violence in the previous 12 months, with more than 50 per cent physically assaulted.
Incidents were most frequent in mental health and the emergency department, with 100 per cent of the respondents working in ED experiencing verbal abuse and 50 per cent physically assaulted. The figures were higher again in mental health, 100 per cent being verbally abused and more than 80 per cent physically assaulted.

Nurses working in surgical and restorative wards also experienced a high level of both verbal and physical violence.

In total, 2354 incidents were reported to the research team, with nurses facing an average of two to 46 incidents a year.

Worryingly, the report found that only 16 per cent of the nurses who experienced violence completed an official incident report. Lead author Dr Rose Chapman said many of the nurses who took part in the research said they did not report incidents because they felt that workplace violence was “just part of the job”.

They also felt they didn’t have management support, Chapman said.

“Violence is not part of the job and until nurses themselves recognise this, change won’t occur,” she said.

“The low rate of reporting means official figures fail to reflect the severity of the situation, which could be why more action isn’t taken by the government and organisations.”

A nurse who experienced violence and spoke to Nursing Review on the condition of anonymity said she wasn’t surprised at the low rate of nurses officially reporting incidents.

Currently working at a major Brisbane hospital, she has been a nurse for almost nine years, much of that time working in the emergency department. She was verbally abused within the first week on the job. It was about another 6 months before she was pushed into a wall by a patient’s brother.

“At the time it was happening, the verbal abuse did upset me but it wasn’t something I dwelled on. While sympathetic, the nurses I was working with pretty much told me to get used to it and not let it get to you,” she said.

“So from day one, I was given the impression that it was normal. And to be honest, while I’m not condoning verbal abuse, I can understand it in some cases. For most people, hospitals are not a happy place to be. Patients and their family and friends are emotional and stressed and as we know the health system doesn’t always work the way it should do.”

Clearly defining what violence is is also a problem.

“If a patient is in pain and takes their frustration out by yelling at you, is that violence? I’m not sure that it is,” the nurse said.

However, being physically threatened, or physically attacked, is a different matter.

“When I was pushed against the wall I was in shock, especially as the man who did it was so angry. It was frightening. I wasn’t hurt – there were no broken bones or bruises. But it did shake me up and for a quite a while after affected the way in which I worked,” she said.

No official report was made but she did speak to a manager. Again, while sympathetic, the manager gave the impression that it wasn’t a serious enough issue to take further. This continued the precedent that was set in her first week.

Since that first year the nurse said she hasn’t kept count of how many times she has been verbally abused or threatened. She made no official reports on the abuse but twice when physically threatened, wanting to get something in writing if anything were to happen.

She has been physically attacked on a number of occasions but has only reported a handful, usually for legal reasons.

“I wouldn’t say that I’m used to it (being attacked), but I have started to see it as part and parcel of the job. I have worked with some very supportive management who are very encouraging in reporting any incident, but that is the exception rather than the rule,” she said.

“And that is not because they don’t care. Hospitals can be busy places and many are stretched in resources so it just isn’t given the time.”

Some responsibility also lies with senior staff, she said. “When you start out you look to the senior nurses as an example of how things are done. If they are assaulted or abused, or witness someone experiencing violence, and shrug it off, that sets the norm. I’m guilty of that myself.”

Management need to play a key role in changing nurses attitudes by encouraging them to report any incident and providing the support to do this, Chapman said.

“There needs to be both visible and non-visible support. Visible support includes providing appropriate security and distress alarms. Non-visible support is just as important and is such things as providing nurses with the time and help to fill in the paperwork, time to debrief and encouragement,” she said.

“Nurses feel pressured and don’t think they can take the 15 minutes or half hour away from work to fill in the form. They need to be told that this is ok.”

Understanding why nurses do or do not report incidents is important, since this could help educators and administrators develop programs that help reduce workplace violence, said Chapman.

“Further research on how individuals adapt to violence in the workplace is also warranted,” she said.

Out of harms way
If the figures are any indication, the safest wards to work on are maternity and paediatric. Nurses working on those wards reported the lowest amounts of all forms of workplace violence, and the abuse they received also tended to be verbal rather than physical. Of respondents working in the maternity area, 73.3 reported experiencing verbal abuse, 26.7 per cent a physical threat and 26.7 per cent were physically assaulted.